诱导膜技术结合骨搬运技术两阶段治疗胫骨创伤后骨髓炎  

Treatment of post-traumatic tibial osteomyelitis by two-stage bone transport combined with induced membrane technique

作　　者：任鹏[1] 阿不来提·阿不拉[1] 夏依买尔旦·买买提 马创[1] 阿里木江·阿不来提[1] 买买艾力·玉山 程二林 艾合买提江·玉素甫[1] 

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,乌鲁木齐830054

出　　处：《中华创伤骨科杂志》2017年第10期880-885,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81560350,81360270）

摘　　要：目的探讨应用诱导膜技术结合骨搬运技术2阶段治疗胫骨创伤后骨髓炎的临床疗效。方法回顾性分析2009年2月至2015年8月通过诱导膜技术结合骨搬运技术2阶段治疗的14例创伤后胫骨骨髓炎患者资料。男12例，女2例；年龄26～59岁，平均40．4岁。按Cierny＆Mader分型均为Ⅳ型。病程6～30个月，平均15．3个月。采用此治疗方案之前手术次数为2～6次（平均3．3次）。第1阶段手术：按术前设计安装胫骨延长型外固定支架，早期扩创，广泛切除胫骨骨髓炎病灶，骨缺损长度为4～18cm（平均8．5cm）。将混有质量百分比为10％万古霉素的聚甲基丙烯酸甲酯（PMMA）骨水泥塑形，放置于骨缺损处。第2阶段手术：切开PMMA骨水泥形成的诱导膜，取出PMMA骨水泥，打通髓腔，再缝合诱导膜。在胫骨手术设计的部位进行截骨。2个阶段间隔时间为4～7周（平均4．8周）。末次随访时采用Paley评分标准评定疗效，并记录并发症发生情况。结果术后所有患者获15～50个月（平均17．5个月）随访，均未出现骨髓炎复发。总治疗时间为11～19个月（平均14．7个月）；总带架时间为10～18个月（平均13．2个月），外固定支架指数为31～75d／cm（平均48．5d／cm）。末次随访时按照Paley评分标准评定疗效：优11例，良3例。9例患者出现针道感染，6例患者出现骨搬运后轴向偏移，5例患者出现对接端愈合不良或不愈合。结论诱导膜技术结合骨搬运技术2阶段治疗创伤后胫骨骨髓炎，能够彻底治愈骨髓炎，手术方式简单，效果良好。Objective To study the clinical efficacy of two-stage bone transport combined with induced membrane technique in the treatment of post-traumatic tibial osteomyelitis. Methods A retrospective study was conducted of the 14 patients with post-traumatic tibial osteomyelitis who had been treated by two-stage bone transport combined with induced membrane technique from February 2009 to August 2015. They were 12 males and 2 females, aged from 26 to 59 years （average, 40. 4 years）. By the Cierny ＆ Mader classification, they all belonged to type Ⅳ. Their disease course ranged from 6 to 30 months, averaging 15.3 months. The number of their previous operations ranged from 2 to 6 times, averaging 3.3 times. In the first stage of operation, tibial extended external fixation was installed according to preoperative design, followed by early debridement and extensive removal of osteomyelitis lesion. The length of bone defect after resection of osteomyelitis lesion was from 4 to 18 cm （average, 8.5 em）. 10% vaneomycin-eontained polymethyl methacrylate （PMMA） bone cement was molded and placed in the bone defects. In the second stage of operation, the PMMA-induced membrane was opened to remove the PMMA bone cement, the bone marrow was drilled through and the induced membrane was then sutured up. Tibial osteotomy was conducted at an appropriate part. The average interval between the first and second stages was from 4 to 7 weeks （average, 4.8 weeks）. The clinical efficacy was evaluated according to the Paley criteria at final follow-ups. Complications were recorded. Results All the patients were followed up for 15 to 50 months （17.5 months）. No relapse of osteomyelitis occurred. The total treatment time ranged from 11 to 19 months, with an average of 14. 7 months. The total time for external fixation was from 10 to 18 months, averaging 13.2 months. The external fixator indexes ranged from 31 to 75 day/cm, with an average of 48.5 day/cm. According to Paley criteria at final follow-ups, the clinical efficacy was

关 键 词：胫骨 骨髓炎 外固定器 诱导膜 骨搬运 

分 类 号：R687.3[医药卫生—骨科学]